| NPI | 1760609663 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANELLE RICHARDS Clinical Psychologist 718-541-6453 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 017079) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY 017079) |
| 103G00000X Clinical Neuropsychologist (Licence: NY 016824) | |
| 103T00000X Psychologist (Licence: NY 017079) | |
| 103T00000X Psychologist (Licence: NY 016824) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: NY 017079) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: NY 016824) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 017079) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 016824) | |
| 103TC0700X Psychologist, Clinical (Licence: NY 016824) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 016824) | |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2011-08-25 |